What If My Workers’ Compensation Claim Is Denied?

If you are hurt on the job, we are the team that can help you.Barry R. Lerner


Know Your Rights

Although the law requires almost all Florida employers carry workers’ compensation insurance to cover lost income benefits and medical expenses of injured workers, insurance companies do not always do the right thing by paying out the benefits to workplace injury victims. Sadly, workers’ compensation insurance companies often put their profits before the well-being of people which forces these injured victims to use legal remedies to get their benefits.

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Workers Comp Nav.

Petition For Benefits

If an insurance company refuses to pay the injured employee benefits by denying a claim, he or she may file a petition for benefits with the Florida Division of Administrative Hearings. The petition is then sent to a local Office of the Judges of Compensation for processing.

Once an insurance company receives a notice of a petition for benefits, they have 14 days to either pay the claim or respond to the petition with the Office of Judges of Compensation. The insurance carrier must explain to the judge all of the benefits requested and reasons for denying their dispersal.

After receiving the insurance company’s response, the judge’s office schedules a legally mandated mediation conference to try and resolve the claim out of court. Mediation must take place within 130 days of the filing for petition of benefits.

The mediator is an independent party utilized to facilitate a settlement. At mediation, there is no evidence or testimony taken and the information discussed cannot be used in appeals hearings. Furthermore, the mediator’s recommendations, if any, are not binding and are merely suggestions on how to best bring the matter to a close.

Pretrial Hearings

Should attempts at mediating the claim be unsuccessful, the judge overseeing the case will schedule a pretrial conference to lay the groundwork for the upcoming hearing. The purpose of a workers’ compensation pretrial hearing is to:

  • Understand and simplify the claim and defenses
  • Stipulate to facts and documents
  • Present and examine exhibits for identification
  • Furnish the other side with names and addresses of witnesses
  • Exchange written expert reports offered at trial
  • Schedule the final hearing
  • Consider additional mediation or settlement talks

Final Hearing

A final hearing will take place no more than 210 days after the petition for benefits is filed. The final hearing is essentially a trial in front of a judge to try and settle a claim once and for all. During the final hearing, each side’s attorney will call and cross examine witnesses, scrutinize evidence and expert reports, and advocate vigorously for their client’s legal interests.

Shortly after the conclusion of the final hearing, the judge will issue his or her final decision on the matter. Appeals to the final ruling may be filed and if accepted will be heard by a three-judge panel of the Florida First District Court of Appeal. Appellate judges usually only overturn the lower judge’s ruling if the judge failed to properly apply the law or if the ruling does not support the facts of the case.

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